‘'Sickle Cell and Deaths in Custody'
Professor Gwyneth Boswell, University of East Anglia, Norwich
Professor Simon Dyson, De Montfort University, Leicester
The meeting was opened by the President of the LSA, Dr Christine Bell who gave the apologies of the LMI President, Professor Sir Ian Gilmore, who was unable to attend due to an international commitment.
Dr Bell then introduced the speakers, Professor Gwyneth Boswell, visiting Professor at the University of East Anglia and Professor Simon Dyson Reader in Applied Sociology at De Montfort University Leicester.
Professor Dyson started his talk by looking at sickle cell in its various forms. Unfortunately, both in the criminal justice system and the media, sickle cell had been simplified to mean one thing instead of the range of conditions that it actually is. He spoke about the differences between sickle cell disease and other forms such as SC disease, sickle beta-thalassaemia and simple sickle cell trait. The over simplification of sickle cell disease had been highlighted in the NCEPOD report of 2008, where one of the key findings described a disproportionately large number of cases had been reported to NCEPOD highlighting sickle cell trait when the trait had not in fact been relevant.
Professor Dyson then looked at the over simplification of the aetiology of sickle cell crises. In the past it had been assumed that the deformation of cells during sickling caused the obstruction of small vessels leading to hypoxia and pain. However, the process of sickling is usually slower than the blood transit time through narrow blood vessels. Consequently, it has latterly been realised that there are far more factors working to produce a sickle crisis. A review in Anesthesiology by Firth and Head (Anesthesiology 101 (3): 766-85) highlighted the fact that adhesion haemolysis and deformation are interlinked all leading to profound disruption of vascular function. They described the disease symptoms stemming predominantly from chronic endothelial damage rather than acute erythrocyte deformation.
Professor Dyson described the common widespread intravascular sickling seen at autopsy which may well have arisen at the time or after death as a result of tissue hypoxia. This common finding had led to sickle cell being named as the cause of death when in fact it had more likely been the result of death and the real cause had not been identified particularly when people had died in custody. Professor Dyson emphasized that people with sickle cell trait had normal life expectancies and did not attend hospital at a greater frequency than people with normal haemoglobin. Consequently, there should be no difference in deaths in custody in people with sickle cell trait compared to the normal population. He also said that it was not just a disease of the black population, it was also present in the Arab and Indian populations and with the ever greater instance of inter-racial marriages, the incidence of the sickle cell gene was rising in the white population. Profession Dyson then looked at sickle cell disease. He highlighted the severe pain associated with crises. Deaths in people with sickle cell disease may be associated with sickle cell but equally may be associated with unrelated illness and the NCEPOD report from 2008 stated that deaths in sickle cell disease patients were not well evaluated and depicted.
Professor Boswell then described the context of the criminal justice system. She said that the prison population had doubled in the last two decades which may have been due partly to the politicisation of crime leading to tougher legislation. She said that the public believed that crime had increased over the last two decades when in actual fact it has fallen. Black and ethnic minority prisoners make up 26% of the prison population which compares with 10% of the general population. In particular, black Briton’s constitute 11% of the prison population as compared with 2.8% of the general population. Therefore she wondered whether black and ethnic minority people commit more crime than white people. This was not borne out by any evidence. However, since the police have been given greater powers to stop and search under section 60 of the criminal justice and public order act in 1994, there had been an escalation in the arrest, detention, prosecution and imprisonment of black people. The Macpherson report of 1999 had gone some way to improve this situation. Subsequently however, this had been partly reversed by section 44 of the terrorism act of 2000 which had been made worse by the events of 9/11.
Professor Boswell then looked at deaths in custody. She said that these were due to pre-existing physical and mental ill health, self-harm and suicide, undue physical restraint, a lack of care and occasionally the murder of inmates by their peers. Research from 2007 had demonstrated that young black men in custody are the most likely group to die due to excessive force from police or prison officers. Sickle cell has been used in the past to try and explain this away. Prison health care provision has been made worse by overcrowding and the inappropriate imprisonment of those with mental health problems which has not been helped by the change in budgetary responsibility in 2006.
Professor Boswell concluded with her views that decisions in the criminal justice process could lead to the incarceration of already vulnerable people, whose health care needs were likely to be exacerbated in prison.
Professor Dyson then continued the talk and looked at two aspects of sickle cell. Those whose sudden death had been firstly mis-attributed to sickle cell trait and secondly those due to a lack of care for prisoners with sickle cell disease. He started by looking at the case histories of a number of people who had died in custody. The first case was that of Dennis Stevens, a man with sickle cell trait who died in custody. His death was initially attributed to sickle cell although this was subsequently overturned two years later. A further case in 2003 was Mikey Powell, another man with sickle cell trait, who had been labelled by the media as having died from a sickle cell anaemia crisis. In 2009 an inquest ruled that he had died from positional asphyxia having been run over, hit with batons, CS spray, restrained in the prone position in a police van. Professor Dyson went over several more recent cases before going on to the poor care sometimes given to people arrested who have sickle cell disease. Arrests may precipitate a crisis which is then ignored by police and prison officers when it occurs. Professor Dyson concluded that sickle cell was increasingly the most common genetic condition not only in this country but also the world. He cited some statistics that 1:1800 births in the UK had sickle cell disease and 1:75 had sickle cell trait.
Dr Bell thanked the speakers for their presentation and took some questions from the floor. Dr Nagaraja gave the vote of thanks and the meeting finished at 20:15.
6th February 2012